AIRWAY EXAMPLES

Primary Snoring

• The smaller the airway, the more severe the OSA.
• The more swollen the airway, the more severe the OSA.
• The more marked the airway collapse is on Muller's maneuver, the more severe the OSA.
• For similar findings on dynamic nasopharyngoscopy, the OSA will be more severe in men and the elderly.
• For similar findings on dynamic nasopharyngoscopy, men and post - menopausal women who are similar in other respects will have the same severity of OSA.

These rules of thumb are illustrated in the series of pictures shown on the following page.

The first series are from a woman in her early thirties whose snoring bothered her husband but who had no symptoms of OSA and had a normal oximetry (ODI < 3). Her velopharynx is shallow and shows mild collapse with Muller's maneuver. There is lateral widening of the airway with jaw thrust and minimal AP collapse with the jaw open.

The second series is from a man in his mid - forties who snores, has symptoms of OSA, and findings consistent with Mild OSA on oximetry (ODI of 8). There was moderate lateral wall collapse with Muller's maneuver. The airway dilates with jaw thrust and there was moderate AP collapse with Muller's maneuver.

The third series is from a man in his mid - thirties who snores, has symptoms of OSA, has hypertension and frequent PVCs, and who has findings consistent with Moderately Severe OSA on oximetry (ODI of 15). The airway was edematous and showed marked lateral wall collapse with Muller's maneuver. The airway still dilates well with jaw thrust and there was mild inward collapse with the jaw open.

The fourth series is from a man in his late - fifties who snores, has symptoms of OSA, has hypertension and insulin - resistant NIDDM, and who has findings consistent with Severe OSA on oximetry (ODI of 50). The airway was very small and edematous. It showed marked collapse with Muller's maneuver. The soft palate sagged on jaw thrust (a finding that indicates damage to the neuromuscular apparatus) and there was marked collapse with the jaw open.

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